Need Help - 2 Doctors Telling Me 2 Different Spine Issues

11-11-2011, 07:31 PM

A family member of mine was rear-ended by a heavy duty truck at a high rate of speed a month ago. He went to the ER and was released. Severe back pain continued, so they ran an MRI on his T-spine about 1 month after the car wreck.

The MRI said he had a large syrinx within the T-spinal cord, that there may be 2 lumens of the syrinx which is measuring at 9 mm transverse X 6 mm AP with thinning of the cord around the syrinx and the cord is also expanded due to the syrinx.

There is abnormal edema within several vertebral bodies with subtle horizontal fracture lines suggested within T-11 and T-12 with mild edema in the superior endplate regions of T7 and T5.

DOCTOR 1: Tells my family member his back is all messed up, that he has a fracture to T11 and T-12 with other issues throughout the T-spine.

DOCTOR 2: The surgical consult says to drain the spinal fluid which has leaked out, but that my family member's back is not that bad and there are no fractures.

Can anyone please advise me on how bad his back really is? What suggestions would you give someone in his position with two contradictory answers on what is wrong with his back? Any thing else he should know about these injuries (i.e., recovery time, treatment, what to ask the doctors)? Thank you in advance for your assistance.

Get a 3rd opinion ASAP from a trauma surgeon who would be willing to consult with a different neurologist and a different orthopedic surgeon and perhaps get a better quality MRI. Something is very wrong when 2 docs have such radically different interpretations of the tests.

Comment

A family member of mine was rear-ended by a heavy duty truck at a high rate of speed a month ago. He went to the ER and was released. Severe back pain continued, so they ran an MRI on his T-spine about 1 month after the car wreck.

The MRI said he had a large syrinx within the T-spinal cord, that there may be 2 lumens of the syrinx which is measuring at 9 mm transverse X 6 mm AP with thinning of the cord around the syrinx and the cord is also expanded due to the syrinx.

There is abnormal edema within several vertebral bodies with subtle horizontal fracture lines suggested within T-11 and T-12 with mild edema in the superior endplate regions of T7 and T5.

DOCTOR 1: Tells my family member his back is all messed up, that he has a fracture to T11 and T-12 with other issues throughout the T-spine.

DOCTOR 2: The surgical consult says to drain the spinal fluid which has leaked out, but that my family member's back is not that bad and there are no fractures.

Can anyone please advise me on how bad his back really is? What suggestions would you give someone in his position with two contradictory answers on what is wrong with his back? Any thing else he should know about these injuries (i.e., recovery time, treatment, what to ask the doctors)? Thank you in advance for your assistance.

Victorod,

Your family member is going through a fairly common situation that happens to many people who have had an injury to the spine with seemingly no damage to the spinal cord but now has pain and the MRI shows that the spinal cord probably had been damaged.

The first and most important determination for your family member is to find out whether the spine is unstable. If it is, surgery needs to be done to stabilize the spine. This might help reduce the pain. He may want to find a third neurosurgeon (or orthopedic surgeon) to provide this opinion, since the second doctor apparently thinks that there are no fractures. Please note that MRI is not the best way to detect fractures. When there is a question about possible fracture, a CT scan should be done.

The second question is whether anything can be done about the spinal cord injury now. The MRI shows that he has a syringomyelic cyst, as well as some atrophy of the spinal cord. This suggests that he has had mild spinal cord injury. However, you do not mention whether he has sensory loss and motor loss, whether is bladder and sexual function is okay, etc. If he is neurologically intact, I suggest that they do a followup MRI in 6 months to see if the syringomyelic cyst is expanding and do a good neurological examination at the time to find out whether he is deteriorating neurologically. If not, then it is probably best to leave the spinal cord alone.

Wise.

Comment

Thank you both for your assistance. Your answers are a big help in putting in injury in context. It definitely sounds like a second (or I guess third, depending on how you look at it) opinion is warranted. Also, I don't believe a CT scan has been done, and probably needs to at this point.